Medical Claims Quality Assurance Specialist

1 week ago

Southfield, United States MEDLOGIX, LLC Full time
Job Overview

Position Title: Claims Quality Assurance Reviewer
Company: MEDLOGIX, LLC
Location: Hybrid Work Environment

About MEDLOGIX: MEDLOGIX is dedicated to providing advanced medical claims solutions through effective collaboration of our Integrity technology, skilled professionals, and extensive healthcare provider networks. Our focus is on delivering exceptional service while prioritizing the needs of our clients.

Role Summary: The primary function of this role is to uphold quality standards by identifying specific requirements and ensuring that deliverables meet client specifications and regulatory mandates. The deliverables include medical reports resulting from Independent Medical Examinations (IME's), Peer Reviews, and other related medical documentation.

Key Responsibilities:

  • Conduct thorough quality assurance evaluations of independent medical examination reports, peer review documents, correspondence, addendums, and supplemental reviews.
  • Verify that clear, concise, and evidence-based rationales are provided to support all recommendations and determinations.
  • Ensure adherence to client instructions and specifications, addressing all inquiries appropriately.
  • Maintain the highest standards of content, format, and professional presentation in all reports, ensuring compliance with company guidelines.
  • Identify and rectify any inconsistencies within the reports.
  • Engage with physicians and adjusters/attorneys/paralegals to facilitate timely report delivery and monitor turnaround times.
  • Assist in resolving customer complaints and quality assurance challenges as necessary.
  • Maintain proficiency in company software systems and databases.

Qualifications:

  • Preferred: College degree or equivalent experience in claims adjusting.
  • Strong time management, problem-solving, and organizational skills with the ability to work independently.
  • Exceptional communication skills, including the ability to convey information accurately and listen effectively.
  • Ability to maintain confidentiality and foster a positive team-oriented environment.
  • Capability to focus and concentrate in both normal and high-distraction environments.
  • Ability to perform well under pressure and manage unexpected changes or delays.
  • Reliability and adherence to company attendance policies.
  • Proficiency in Microsoft Office applications is essential.
  • Knowledge of claims and medical terminology, particularly in No Fault, Workers Compensation, or Liability, is preferred.
  • Experience in reviewing IME and/or Peer Review reports is advantageous.

Diversity and Inclusion: MEDLOGIX is committed to providing equal employment opportunities to all employees and applicants, prohibiting discrimination and harassment of any kind. This policy applies to all aspects of employment.

  • Independent Medical Examination Quality Reviewer

    2 weeks ago

    Southfield, United States MEDLOGIX, LLC Full time

    Job OverviewPosition Title: Claims Quality Assurance ReviewerCompany: MEDLOGIX, LLCLocation: Hybrid (2-3 days a week in office)About MEDLOGIX: MEDLOGIX is dedicated to providing advanced medical claims solutions through effective collaboration of our innovative technology, skilled personnel, and extensive healthcare provider networks. Our focus is on meeting...

  • Client Services Quality Assurance Specialist and Dispute Resolution

    2 months ago

    Southfield, United States Nyman Turkish PC Full time

    Job DescriptionJob DescriptionJob Description: Quality Assurance SpecialistNyman Turkish, a renowned law firm specializing in Social Security Disability and Workers' Compensation, is in search of an exceptional “Quality Assurance Specialist” to join our dynamic team. This role is pivotal in ensuring the accuracy and efficiency of our case management...

  • IME Claims Reviewer

    1 month ago

    Southfield, United States MEDLOGIX, LLC Full time

    Job DescriptionJob DescriptionJob Title: Claims Reviewer/ QA ReviewerLocation: Southfield, Michigan (Hybrid, 2-3 time a week in MI office)MEDLOGIX delivers innovative medical claims solutions through a seamless collaboration of our Integrity technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to...

  • Quality Assurance Engineer

    2 weeks ago

    Southfield, Michigan, United States PHOENIX DATA SYSTEMS INC Full time

    Quality Assurance EngineerJob Title: Quality Assurance EngineerLocation: Remote or Southfield, MIPosition Type: Full-time, SalariedPosition OverviewWe are seeking a dedicated QA Engineer to join our team, focusing on our premier AIMS 3 product, a sophisticated Computerized Maintenance Management System tailored for clinical and facility engineering. Our...

  • Medical Office Specialist

    2 months ago

    Southfield, United States Comprehensive Sleep Solutions Full time

    Job DescriptionJob DescriptionComprehensive Sleep Solutions & Diagnostic Center is a company in Southfield, MI 48034.We are looking for an Medical Office Specialist/Assistant Medical Biller in our office in Southfield. Must be detailed oriented, strong computer skills, 2 yrs experience in healthcare billing preferred but not required. Position includes...

  • Independent Medical Examination Auditor

    1 week ago

    Southfield, United States MEDLOGIX, LLC Full time

    Job OverviewPosition Title: Claims Quality Assurance ReviewerCompany: MEDLOGIX, LLCLocation: Hybrid (Remote and in-office collaboration)About MEDLOGIX: We specialize in delivering advanced medical claims solutions through a combination of innovative technology, skilled professionals, and extensive healthcare provider networks. Our commitment to excellence...

  • Claims Processing Specialist

    1 week ago

    Southfield, Michigan, United States Great Expressions Dental Centers Full time

    Job Summary:This position will be responsible for handling the day-to-day functions related to the successful processing of dental insurance claims for Great Expressions Dental Centers.The role will be responsible for processing payments to accounts according to company policies and procedures.Key Responsibilities:Post fundamental payer payments as...

  • Quality Assurance Engineer for Test Automation

    2 weeks ago

    Southfield, Michigan, United States Unified Tech Group Inc Full time

    Job OverviewSalary: CompetitiveKey Responsibilities:Engage in requirement assessments to develop comprehensive testing procedures and cases.Create test scenarios for both black-box and white-box testing methodologies.Establish testing strategies aligned with software development timelines.Formulate and update test plans in accordance with the software...

  • Medication Management Specialist

    2 weeks ago

    Southfield, Michigan, United States ChenMed Full time

    Join Our Transformative Team!At ChenMed, we believe in the power of innovation and compassion. We are dedicated to enhancing the lives of our patients and team members alike. Are you a proactive and driven individual with a passion for healthcare? Do you thrive in a collaborative environment and inspire those around you with your positivity? If so, we invite...

  • Medical Support Specialist

    4 days ago

    Southfield, Michigan, United States Concentra Full time

    About the RoleWe are seeking a highly skilled and compassionate Medical Support Specialist to join our team at Concentra. As a vital member of our patient care team, you will play a crucial role in providing exceptional care to our patients.Key ResponsibilitiesPerform routine medical and testing procedures under direct supervision of the treating...

  • Software Quality Assurance Automation Educator

    2 weeks ago

    Southfield, Michigan, United States Global Information Technology Full time

    Job OverviewGlobal Information Technology is a leading provider of professional IT training and consulting services, dedicated to equipping students with the essential skills and mindset required for success in their respective fields. We are currently seeking a qualified Software QA Automation Instructor to deliver training sessions during evenings and...

  • Software Quality Assurance Automation Educator

    2 weeks ago

    Southfield, Michigan, United States Global Information Technology Full time

    Job OverviewGlobal Information Technology is a leading provider of professional IT training and consulting services, dedicated to equipping students with essential skills for career advancement. We are currently seeking a Software QA Automation Instructor to deliver engaging training sessions during evenings and weekends.Key QualificationsProficient in...

  • Software Quality Assurance Automation Educator

    2 weeks ago

    Southfield, Michigan, United States Global Information Technology Full time

    Job OverviewGlobal Information Technology is a leading provider of professional IT training and consulting services, established in 1999. We are dedicated to equipping our students with the essential skills and mindset needed to thrive in their chosen careers. We are currently seeking a Software QA Automation Instructor to deliver training sessions during...

  • Medical DME Claims Processor

    4 weeks ago

    Southfield, United States TEKsystems Full time

    Career Opportunity:  Remote after 3 weeks of Training ONSITE Job Title: Case Review / Benefits Specialist Industry: Medical/Insurance/Benefits Hours: 830AM – 5PM M-F Pay Rate: $ Training Location: Madison Heights, MI Start Date Expected: 9/4/2024 Interview Date: Middle of August Weekends: No Benefits: Yes Permanent: Yes Contract to...

  • Medical DME Claims Processor

    4 weeks ago

    Southfield, United States TEKsystems Full time

    Career Opportunity: Remote after 3 weeks of Training ONSITEJob Title: Case Review / Benefits SpecialistIndustry: Medical/Insurance/BenefitsHours: 830AM – 5PM M-FPay Rate: $15.50/HRTraining Location: Madison Heights, MIStart Date Expected: 9/4/2024Interview Date: Middle of AugustWeekends: NoBenefits: YesPermanent: YesContract to Hire: 90-day contract to...

  • Healthcare Claims Processing Specialist

    1 week ago

    Southfield, Michigan, United States TEKsystems Full time

    Career Opportunity: Remote after 3 weeks of Training ONSITE Job Title: Case Review / Benefits Specialist Industry: Medical/Insurance/Benefits Hours: 830AM – 5PM M-F Pay Rate: $ Training Location: Madison Heights, MI Job Overview: The Case Review Specialist plays a crucial role in managing communications with patients, referral sources,...

  • Healthcare Claims Processing Specialist

    2 weeks ago

    Southfield, Michigan, United States TEKsystems Full time

    Career Opportunity: Remote after initial training period Job Title: Case Review / Benefits Specialist Industry: Medical/Insurance/Benefits Hours: 830AM – 5PM M-F Pay Rate: $ Job Overview: The Case Review Specialist plays a crucial role in managing communications with patients and clients, ensuring accurate verification of eligibility,...

  • Healthcare Claims Processing Specialist

    1 week ago

    Southfield, Michigan, United States TEKsystems Full time

    Career Opportunity: Remote Position Available After Initial Training Period Job Title: Case Review / Benefits Specialist Industry: Medical/Insurance/Benefits Working Hours: 830AM – 5PM M-F Compensation: Competitive Pay Rate Job Overview: The Case Review Specialist plays a vital role in managing all aspects of in-house communication with...

  • Medical Equipment Delivery Specialist

    4 days ago

    Southfield, Michigan, United States Hart Medical Equipment Full time

    Job SummaryHart Medical Equipment is seeking a highly skilled and compassionate Medical Equipment Delivery Specialist to join our team. As a key member of our patient care team, you will be responsible for delivering, setting up, and providing instruction on the proper use and care of medical equipment to our patients.Key ResponsibilitiesDeliver and Set Up...

  • Card Quality Assurance Specialist

    2 weeks ago

    Southfield, Michigan, United States Evolution Americas Full time

    Job OverviewYou will play a crucial role in ensuring the quality and integrity of card products, adhering to the high standards set by Evolution Americas and your direct supervisor.Key Responsibilities- Collaborate effectively within your team to achieve targeted outcomes while meeting company deadlines.- Conduct inspections of a specified number of card...